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CHAPTER 4
Mental Health Care for American Indians and Alaska Natives
Appropriateness and Outcomes of Mental Health Services
During the past decade, many guidelines for treating mental disorders have been
offered to ensure the provision of evidence-based care. Even though
few American Indians or Alaska Natives were included in the studies
that led to their development, such professional practice guidelines
offer the clearest, most carefully considered recommendations available
regarding appropriate treatment for this population. They therefore
warrant special attention.
The DSM–IV, both within the main text and in its “Outline for Cultural
Formulation,” does provide clear guidelines for addressing cultural
matters, including those specific to this population, in the assessment
and treatment of mental health problems (Manson & Kleinman, 1998;
Mezzich et al., 1999). A growing body of case material demonstrates
the utility of applying these guidelines to American Indian children
(Novins et al., 1997), as well as to adults (Fleming, 1996; Manson,
1996; O’Nell, 1998).
Novins and colleagues (1997) critically analyzed the extension of the “Outline
for Cultural Formulation” to American Indian children. Drawing
upon rich clinical material, they demonstrated the merits and utility
of this approach for understanding the emotional, psychological, and
social forces that often buffet Native children. However, Novins and
his colleagues underscored the importance of obtaining the perspectives
of adult family members and teachers, as well as the children themselves,
which is not explicitly considered in the formulation.
No studies have been published regarding the out-comes associated with standard
psychiatric care for American Indians and Alaska Natives. Hence, it
is not known if practitioners accurately diagnose the mental health
needs of American Indians and Alaska Natives, nor whether they receive
the same benefits from guideline-based psychiatric care as do whites.
For this we must await related studies of treatment outcome, studies
that venture beyond the limitations of current thinking with respect
to intervention technology and best practices.
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